C477 – Subsequent visit - sixth to thirteenth week inclusive
OHIP Surgical Procedures Code — CONSULTATIONS AND VISITS · Schedule of Benefits
A subsequent visit for a hospital in-patient from the sixth to the thirteenth week inclusive. A subsequent visit is any routine assessment in hospital following the hospital admission assessment. In addition to the common elements, this service includes the specific elements of an assessment as defined on page , such as a direct physical encounter, history taking, examination, and discussion with the patient. See General Preamble page for general rules on subsequent visits.
When to Use
- Use C477 for routine daily hospital rounds once the patient has reached the 6-week mark post-admission, continuing through the end of the 13th week.
- Use this code for patients who have had a prolonged hospital stay exceeding 42 days, transitioning from the C472 (second to fifth week) billing tier.
Common Pitfalls
- Billing C477 beyond the 13th week of admission; once the patient enters the 14th week, you must transition to C479 (subsequent visit after 13th week).
- Failing to track the admission date accurately, leading to 'out of sequence' rejections when billing C477 before the 6-week threshold or after the 13-week limit.
- Attempting to bill C477 alongside C121 (intercurrent illness) for the same patient on the same day, which is explicitly prohibited by the E083/E084 premium rules.
Billing Tips
- If you are the Most Responsible Physician (MRP) and meet the remuneration criteria, always append E083 for weekday visits or E084 for weekend/holiday visits to maximize the C477 base fee.
- Ensure your documentation clearly reflects the date of admission to justify the transition from C472 to C477, as this is a common target for post-payment audit verification.
Effective: June 1, 2025
A. Consultations and Visits
CONSULTATIONS AND VISITS
Assessment
Hospital and Institutional Consultations and Assessments, Assessments
As per general medical record requirements outlined on page , the record must establish that an insured service was provided, the service claimed is the service rendered, and the service was medically necessary.
Payable for subsequent visits from the sixth to thirteenth week inclusive after admission.
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